Swedish midwives’ experiences and views of amniotomy: An interview study

Abstract

Objective To explore midwives’ experiences and views of amniotomy. Design A qualitative inductive design was used. Data were collected using interviews and analysed with content analysis carried out with NVivo 12. Setting and participants Sixteen midwives working at delivery wards at three hospitals in the south of Sweden. Findings Three categories emerged: “Promote, protect and support the physiological process of labour”, “To make the decision -to do or not to do” and “Unpredictable response”. The overall theme linking the three categories was “We become our decisions”, portraying how midwives carry the responsibility in the decision-making and represent themselves in their handling of amniotomy. Conclusions Amniotomy was experienced and viewed as both simple and complex, safe and risky, and deciding on it sometimes implied balancing contradicting perspectives. By using midwifery skills in the decision-making for an amniotomy, the midwives tried to predict the response, purposing to support physiological labour and promote health for women and babies.

Incidence and risk factors for umbilical cord prolapse in labor when amniotomy is used and with spontaneous rupture of membranes: A Swedish nationwide register study

“…Further, mechanical methods are recommended, rather than medical, for the induction of labor in women with a previous cesarean section, 27,28 and therefore possibly "riskier" amniotomies are performed in this group. 9 Induction of labor was also a risk factor for UCP in both labors with an amniotomy and those with SROM. Boyle & Katz 29 reported the same in a study including data from 1995 to 2001, as so did Kahana et al 2 with data from 1988 to 1999.…”

“…As polyhydramnios is an indication for induction of labor, it is likely that this group undergoes amniotomy more often than parturients without polyhydramnios. Previous studies have suggested performing a “controlled amniotomy” in cases of an unengaged presenting part, as is often the case in the presence of polyhydramnios, by “needling” the amniotic bag, for a slower release of the fluid, and to give mild fundal pressure to assist the presenting part down into the pelvis 6,9 . This is likely used clinically; however, to the best of our knowledge, there are no studies evaluating the benefits and safety of this method.…”

“…The recognized risk factors in singleton pregnancies include: malpresentation, 1,2,4–6 low birthweight, 1,2,5,6 multiparity, 1,2,4–6 polyhydramnios 2,5,6 and labor interventions, such as an amniotomy 3,6,7 . A non‐engaged presenting fetal part at the time of an amniotomy is a confirmed risk factor 6–11 . When UCP occurs, delivery should be expedited 7,8,12 .…”

Prevalence of amniotomy in Sweden: a nationwide register study

“…In our previous study, midwives working at an University hospital experienced that amniotomy was performed due to a constant high work load, therefore we used stratification in order to investigate this issue [ 28 ]. Our results in the present study show variations in the prevalence of amniotomy between Swedish hospitals.…”

“…A first step in addressing an inappropriate use of labor interventions is to explore regional variations in the prevalence within the country [ 8 ]. It is of importance to acknowledge that amniotomy is performed for several reasons, occasionally laboring women even request it, as described in our previous study [ 28 ]. This fact may contribute to differences in the prevalence between hospitals.…”